Dialysis 9 yrs, but terminal illness is COPD??? - page 2
Sometimes I just want to pull my hair out! Account exec has been working on getting a patient discharged for the last 3 weeks, daily notes from md says "husband considering stopping dialysis", then,... Read More
May 11, '09IMHO it is all a game! We have hospice patients on Dialysis, on tube feeds, on TPN and we have full codes! my last admission was a DNI but yes to CPR - until I explained and they changed their mind right then and there and made the pt a DNR- does not always happen! The full codes are the least of our problem, most of our patients are at home and if/when family does call 911 and the paramedics hear this is a hospice pt they do not intubate; the TPN patients frustrate me most. We had an inservice not too long ago, and the explanation was that other hospices (we are one of 7 or 8 here) offer palliative care not just hospice, for the people who are not in the hospice frame of mind and hope to live longer if they still get treatment. So hospice will eat the cost of TPN and other treatments (yes, even chemo if it is sen as palliative). Most of the chemo receiving patients have only one more treatment, then are physically not able to do it any more. It is a numbers game in my mind. If one more chemo, one more radiation makes the families some times the patients feel better about starting hospice so be it. This society fights dying at all cost (financial as well as physical), though it claims to believe in a life after this. My thought: it is hard to let go! However, we all are destined to go, the only difference is how.
May 27, '09We have had patients without the DNR orders and the careplan is adjusted to reflect the need for intensive social services to manage awareness and coping with decision making. It doesn't always work, but sometimes the family is in need of hand holding to get through the major decisions.